Nursing Ethical Dilemma and Decision Making Essay

Excerpt from Essay :

Ethical Dilemma


The following paper will narrate an ethical dilemma which has been faced by a nurse working is a local emergency department. The analysis of the dilemma will be done using Catalano’s (2009) ethical decision making algorithm for nurses. Various potential solutions to the dilemma will be discussed along with an examination of both the positive and negative consequences of the decision.

This ethical dilemma, faced by the emergency department nurse was related to a 93 year old patient who was transferred from an extended care facility. The patient had been diagnosed with Alzheimer’s disease. She was unable to eat or drink at all which was not enough to sustain her health. The patient would not give any response to any voice or touch. She was non-verbal. Her physician at the extended care facility had diagnosed her with failure to thrive. Her granddaughter was the power of attorney. The patient did not own an advanced directive. An emphasis had been laid by the patient’s family that she must be sent to the emergency department so she gets to have a feeding tube placed. The patient’s family told that they were assured that “the patient might get better is feeding tube was placed”. Now, the nurse was facing an ethical dilemma of supporting the patient’s right to a dignified demise and balancing the wishes of the family (Heiser, 2014).

Analysis of the dilemma

The decision making starts with assessment according to Catalino’s (2009) ethical decision-making algorithm. The first step involves the collection, analysis and interpretation of data. The decision involves determining which party will be influenced the most by the decision. The second step is to state the dilemma. In this case, the dilemma for the nurse is to fulfill the family’s desire and support the right of her patient to a dignified death. The third step involves collection of enough facts, including the potential threats to the patient’s life. The provided information is used to chalk down the possible outcomes (Deshpande, 2009).

In relation to the first step, the family’s wishes were assessed by the nurse. The nurse was told by the power of attorney that she wanted to get a feeding tube fixed. She further added that she was assured at the extended care facility that the patient would get better by placement of feeding tube. As per nurse’s assessment of the family’s understanding of Alzheimer’s disease, they did not have the knowledge that this disease was a progressive one. It is an irreversible form of dementia (Porth, 2010). They were unaware of the fact that there would be no effect on patient’s quality of life and progression of the patient’s Alzheimer’s disease by simply providing nutrition. The nurse must next consider the physical condition of the patient. The patient was not capable of communication or decision-making. She had a stage three decubitus ulcer on her coccyx. Placing a feeding tube would do nothing to improve patient’s quality of life.

The second step involves the dilemma of catering for the family’s desires or to support the patient’s right to a dignified death. Coming to the third step, there can be a possibility to have the tube fixed by a surgeon. But the other option would be offering hospice care to the patient and family. A third option can involve medically clearing the patient and returning her to the ECF. The nurse must take into consideration all the information gathered. This will help in solving the dilemma. The nurse’s further decision will depend on the possible solutions and outcomes.

Resolution of the dilemma

According to Blais…

Sources Used in Document:


Blais, K., & Hayes, J. S. (2010). Professional nursing practice: Concepts and perspective (6th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.

Catalano, J. T. (2009). Nursing now! Today’s issues, tomorrow’s trends (5th ed.). Philadelphia: F.A. Davis.

Deshpande, S. P. (2009). A study of ethical decision making by physicians and nurses in hospitals. Journal of Business Ethics, 90(3), 387-397.

Dreyer, A., Forde, R., & Nortvedt, P. (2009, November). Autonomy at the end of life: Life prolonging treatment in nursing homes - relatives’ role in the decision-making process. Journal of Medical Ethics, 35(11), 672-677.

Gladding, S. T. (2000). Counseling: A Comprehensive Profession (4th ed.). Upper Saddle River, NJ: Merrill.

Heiser, G. (2014). End of life ethical dilemma. Journal of Excellence in Integrated Writing Courses at Wright State, 1(7), 1-5.

International Council of Nurses. (2006). The ICN code of ethics for nurses. Retrieved from

Porth, C. M. (2010). Essentials of pathophysiology (3rd ed.). Philadelphia: Lippincott Williams& Wilkins.

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